Re: DOC band and Cigna HMO- so frustrated

[Guest guest]

- I am so sorry to hear about this.

Basically, did you think that Cigna was going to pay for the entire amount,

or were you under the assumption they would only pay for $1000. I'll be

interested to see what they do for me. So far, CT thinks that Cigna will

only pay for $1000, it just depends how they code it.

Where do you go from here?

, mommy to

[Guest guest]

Wow that is a tough one shouldn't they have left well enough alone and can an ins company do that? Doesn't seem fair to me.

beck

STATEINSDEPT

[Guest guest]

I'm sorry , but that sounds absolutely ridiculous. Why would CT do

that? Does Cigna still show that they have the band classified as a dermal

(Or is is durable...I'm not sure) Anyway, if they do, then Cigna SHOULD

cover the whole thing. BTW - How did you find out that CT called them? Were

you doing a f/u with Cigna yourself?

[Guest guest]

I just got off the phone with Cigna and CT in Phoenix. I am so frustrated. We were cast on 1/30. Cigna apparently paid $3000 for my band on 2/12. On, 2/25 CT called to question the payment and Cigna turned around and asked for a refund of $2000. CT said that they called to verify because she didn't realize I had won the appeals and have seen a lot of payment and then the insurance company calling back to say they made a mistake in paying. I feel like my agruement for Cigna paying the full amount was severely compromised by CT.

sricks1@... wrote:

Do you recall what the Hanger Bands cost for Janine and Isabella? The DOC band costs 3 grand. From what I've read, Cigna basically will cover only $1000 of it because that's the price comparable to the Starband. It's crazy. Gail knows some people who had their DOC bands paid for 100% by Cigna, so I'll be curious to see whether or not I can get this thing appealed. Evidently, Cigna is very inconsistent. We shall see., Mommy to (soon to be DOCbanded at 7 mo)For more plagio info

[Guest guest]

Initially, I thought when I won the appeal that Cigna was paying for the $3000. Then CT in Dallas told me what they told you. That they would probably only pay $1000 but that they may pay the whole thing. I just never imagined that CT would call Cigna to question why they were paying the whole thing.

I'm not sure where to go from here. I asked CT to send me what they sent Cigna initially when they paid the $3000 and any other documentation they have. From what I understand they never changed the coding. Cigna interpreted the call from CT as a 'if you don't want $3000 for the claim we want a refund of $2000 instead of verifying that they didn't make an error and weren't going to ask for the money back at a later time. sricks1@... wrote:

- I am so sorry to hear about this. Basically, did you think that Cigna was going to pay for the entire amount, or were you under the assumption they would only pay for $1000. I'll be interested to see what they do for me. So far, CT thinks that Cigna will only pay for $1000, it just depends how they code it. Where do you go from here?, mommy to For more plagio info

[Guest guest]

,

I just read this post to my husband and his immediate response was "time to call an attorney". This is shocking to me. I even think it is worse than my year of appeals nightmares. How can they do this? CT had their money, so why push the issue?! If you're interested, Bill Fynes in Dallas is a name thrown around on this board all the time. He's an attorney with lots of experience in DOC band cases. Let me know if you want his info.

Gail

Re: DOC band and Cigna HMO- so frustrated

I just got off the phone with Cigna and CT in Phoenix. I am so frustrated. We were cast on 1/30. Cigna apparently paid $3000 for my band on 2/12. On, 2/25 CT called to question the payment and Cigna turned around and asked for a refund of $2000. CT said that they called to verify because she didn't realize I had won the appeals and have seen a lot of payment and then the insurance company calling back to say they made a mistake in paying. I feel like my agruement for Cigna paying the full amount was severely compromised by CT. sricks1@... wrote: Do you recall what the Hanger Bands cost for Janine and Isabella? The DOC band costs 3 grand. From what I've read, Cigna basically will cover only $1000 of it because that's the price comparable to the Starband. It's crazy. Gail knows some people who had their DOC bands paid for 100% by Cigna, so I'll be curious to see whether or not I can get this thing appealed. Evidently, Cigna is very inconsistent. We shall see., Mommy to (soon to be DOCbanded at 7 mo)For more plagio info

[Guest guest]

Hey everyone,

Sandy Bruno here at CTI asked me to post the following...

***

To and other parents - CIGNA payment

Cranial Technologies is required to verify all insurance claims.

Unfortunately we cannot accept payments at face value, because when

an insurance company does their annual audit for claims accuracy,

they can (by law) come back to us for refunds. Just last year alone,

the refund was in excess of $75,000 and previous claims for refunds

against CTI have even been placed with collection agencies.

When a parent entrusts us to submit claims on their behalf, we follow

the claim until it is processed, according to the appropriate billed

code and benefits quoted by the insurance company.

I want to assure all DOC Band parents that our staff includes Claims

Research Analysts, who make every effort to get our families the

highest reimbursements; we truly do battle with insurance companies

on your behalf. But we also need to make certain that there are no

surprises six months later, when insurance companies discover their

mistake.

Insurance claims are very frustrating and complex - not only for you

but also for those of us who work with them every day. It's the main

reason we have trained our Claims Analysts and Patient Coordinators

in all that is required to work with this difficult industry.

Sandy Bruno

National Patient Coordinator

Cranial Technologies, Inc.

bruno@...

>

> I just got off the phone with Cigna and CT in Phoenix. I am so

frustrated. We were cast on 1/30. Cigna apparently paid $3000 for

my band on 2/12. On, 2/25 CT called to question the payment and

Cigna turned around and asked for a refund of $2000. CT said that

they called to verify because she didn't realize I had won the

appeals and have seen a lot of payment and then the insurance company

calling back to say they made a mistake in paying. I feel like my

agruement for Cigna paying the full amount was severely compromised

by CT.

>

[Guest guest]

Hi /Sandy,

Thank you for that explanation. It is much appreciated.

> >

> > I just got off the phone with Cigna and CT in Phoenix. I am so

> frustrated. We were cast on 1/30. Cigna apparently paid $3000 for

> my band on 2/12. On, 2/25 CT called to question the payment and

> Cigna turned around and asked for a refund of $2000. CT said that

> they called to verify because she didn't realize I had won the

> appeals and have seen a lot of payment and then the insurance

company

> calling back to say they made a mistake in paying. I feel like my

> agruement for Cigna paying the full amount was severely compromised

> by CT.

> >

[Guest guest]

OH WOW!!! I had no idea, they could do that! Hmmmm...something to

think about. Thanks for posting this, I don't have Cigna, but it is

still nice to know it could happen to anyone.

Dustie

> >

> > I just got off the phone with Cigna and CT in Phoenix. I am so

> frustrated. We were cast on 1/30. Cigna apparently paid $3000 for

> my band on 2/12. On, 2/25 CT called to question the payment and

> Cigna turned around and asked for a refund of $2000. CT said that

> they called to verify because she didn't realize I had won the

> appeals and have seen a lot of payment and then the insurance

company

> calling back to say they made a mistake in paying. I feel like my

> agruement for Cigna paying the full amount was severely compromised

> by CT.

> >

[Guest guest]

I can understand verifying payments. I am frustrated because Cigna

told me they changed the decision for their payment because of what

CT called and told them. CT claims that Cigna misinterpreted the

conversation. I apoligize for venting my frustrations if this is

not the appropriate forum.

Just a side note, how is it possible for there to be any refunds if

all claims are verified?

> >

> > I just got off the phone with Cigna and CT in Phoenix. I am so

> frustrated. We were cast on 1/30. Cigna apparently paid $3000

for

> my band on 2/12. On, 2/25 CT called to question the payment and

> Cigna turned around and asked for a refund of $2000. CT said that

> they called to verify because she didn't realize I had won the

> appeals and have seen a lot of payment and then the insurance

company

> calling back to say they made a mistake in paying. I feel like my

> agruement for Cigna paying the full amount was severely

compromised

> by CT.

> >

[Guest guest]

,

This is a support group, feel free to VENT anytime. That is one of

the reasons we are here! Please don't feel like you can't express

yourself here.

> > >

> > > I just got off the phone with Cigna and CT in Phoenix. I am so

> > frustrated. We were cast on 1/30. Cigna apparently paid $3000

> for

> > my band on 2/12. On, 2/25 CT called to question the payment and

> > Cigna turned around and asked for a refund of $2000. CT said

that

> > they called to verify because she didn't realize I had won the

> > appeals and have seen a lot of payment and then the insurance

> company

> > calling back to say they made a mistake in paying. I feel like

my

> > agruement for Cigna paying the full amount was severely

> compromised

> > by CT.

> > >